Ask the Expert

This month’s selection:
When I queried the physician who did an emergency C-section about whether a particular baby was delivered stillborn or liveborn, her response was that “fetal heart rate was documented prior to C-section; therefore, baby was not stillborn. It was a neonatal death.” 

The baby, when delivered, was intubated and breath sounds were heard through the endotracheal tube, but no heartbeat was heard throughout the course of postdelivery. 

To complicate matters, the physician who attended the baby gave a final discharge diagnosis of “intrauterine fetal demise due to placental abruption.”

Do I code V27.0, V27.9 on the mother’s chart?

Cindy S. Holicky, CCS
Queen of Peace Hospital
New Prague, Minnesota

 

Response:
Liveborn or stillborn is determined by whether the baby took one or more breaths or had one or more heartbeats after delivery. If the infant’s heart and lungs quit during delivery but prior to being delivered, the infant is a stillborn (intrauterine fetal demise; assuming 22 weeks or greater gestational age; assuming not an elective or therapeutic abortion).

The queried doctor clarified that the baby did breathe postdelivery, despite the lack of a heartbeat, and was therefore a livebirth with neonatal death (not intrauterine demise).

But since the queried doctor’s answer conflicts with the final discharge note, the doctor’s clarification needs to be part of the permanent chart, not just an answer on an e-mail or a note on a query form that is not a permanent part of the patient’s chart.

— Judy Sturgeon, CCS, CCDS, is the clinical coding/reimbursement compliance manager at Harris County Hospital District in Houston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and compliance for 21 years.

 

Follow-up question:
I queried the delivering physician, and she stated the baby was not stillborn, that it was a neonatal death. So I need to code V27.0, right? You said a stillborn is determined by whether a baby takes one or more breaths or had one or more heartbeats after delivery. At the end of the C-section operative report, the surgeon states, “There were no spontaneous respirations or heart tones noted as per the pediatrician at birth of the baby.” So that statement makes it a stillborn; regardless, I still need to code from the doctor query and go with V27.0, correct?

— CSH

 

Follow-up response:
One doctor said no spontaneous respirations or heart tones, so that means stillborn. But when asked, the queried doctor said when intubated after delivery, there were breath sounds despite no heartbeat, and that it was in fact a neonatal death, so it really was live born, died (V27.0).

So, if the query doctor documents that in the chart, not just on a query or in an e-mail, then I would code as a liveborn V27.0 and discharge disposition deceased.

— JS